I want to be there when that cancer freight train hits

Sometimes, you can see cancer coming. What I mean is that when we sign up for that mammogram, or that PSA blood test, there has to be some tiny little part of us that says, “Ok, this time it’s my turn. This time I’m the one who’s going to get the call.”

Sometimes the cancer sneaks up on us—that nagging little cough that makes us want to—suddenly and belatedly—quit smoking. Or that little bit of blood in the stool that we’d rather think is a hemorrhoid, or that lump in the neck that doesn’t go away even when our doctor treats us for the strep throat that we know we don’t have. But sometimes, as it happened to my patients yesterday, that cancer hits us like a freight train. Just flattens us and leaves us in fragments, speechless in surprise and terror. And when that train hits, we know in an instant that life will never be the same again.

I had two of the freight train kind of patients yesterday. The first was a man in his 70’s, previously healthy, an avid stamp collector. One day in August, he suddenly had difficulty finding his words. A CT scan done without contrast dye showed no stroke or bleed in his brain, and he was sent home from the emergency room.

His wife persisted with the primary care doctor—”My husband is just not right!” she said, and last month an MRI was ordered which revealed a large ugly looking brain tumor, and the patient was taken to surgery. The pathology returned as glioblastoma multiforme, the most aggressive type of brain cancer. He was seen in outpatient oncology clinic by a young neuro-oncologist, just out of his training. By the time the patient came to me, every shred of hope was gone. The man, still having difficulty with his speech, told me that the doctor said that at most, he would live a year, if he chose treatment, a few months if he did not. He said that the doctor told him that the tumor would spread like a spider web over his brain, and that he would lose all function. The patient cried when he told me this.

The second patient was a very fit man in his early sixties, a retired school teacher who had surfed and been a life guard all his life. In July, he had a surfing accident (his wife said, “Can you believe it? He surfed some of the greatest waves in the world and he wiped out in two feet of water here at home.”) He broke his collarbone in three places, which required surgery to repair. His pain got worse however, and he started to have back pain. Spine films showed a compression fracture, also thought to be related to the accident. As this tan, fit, athletic man began to seek more and more narcotics for his pain, an MRI of the spine was obtained, which showed the bones to be brittle and riddled with tumors. Yesterday the biopsy of his sacroiliac area came back positive for multiple myeloma, a disease of plasma cells in the bone marrow which destroys the bones that cultivate it. In an instant, this nice couple’s dreams of a happy retirement were shattered.

When we first moved to the West Coast, I was offered two very different jobs. In one practice, I was to be the person that rotated through six different outpatient facilities, covering the regular doctor’s vacations. I would see the patients for consultation, and perhaps treatment planning, but would never see them through their treatment or in follow up. The other job was a hospital based practice where I would be the director of the department and have longitudinal care of the patients. I chose the second, of course, because being the linear task oriented person that I am, I could not conceive of not seeing each patient through from start to finish to follow up.

I see things differently now, twenty years later. I have a calling in life. I want to be there when that freight train hits. I know I can put the pieces back together, and I know that when that shattered patient leaves my office, for the first time in hours, or days, he will be able to notice the sun shining in our Southern California sky, and taste a faint flavor of salt on the warm breeze flowing from the Pacific. In turn, I will have the deep satisfaction of knowing that I did something good that particular day. And that, actually, is quite enough.

Miranda Fielding is a radiation oncologist who blogs at The Crab Diaries.

I want to be there when that cancer freight train hits 5 comments

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http://www.facebook.com/mhoggorourke Maryalice Hogg-O’Rourke

A year ago I went to the dermatologist with what I thought was rosacea and left, after some testing, with a diagnosis of polycythemia vera spent phase which has quickly progressed to myelofibrosis. you just never know. It taught me that we are not in as much control of life as we would like to think..
It was a real shock.

Miranda Fielding

I am so sorry to hear of this diagnosis, but I hope that your dermatologist was able to refer you to a hematologist oncologist that has been able to manage your disease well and support you emotionally. Best of luck and thanks for sharing your story.

meyati

I spent about 25 years trying to get a “zit’ removed. It was too small-I couldn’t tell a doctor what to do- they wouldn’t remove it for my vanity-insurance wouldn’t pay for something so small- they would be censored by the lab and their peers. It finally burrowed deep enough to make a nerve inside of my mouth hurt.. It’s a type of cancer atypical BCC that won’t respond to radiation or chemotherapy. It might be dripping down into my lungs causing lung cancer. I’m 70-and medicare and the HMO doesn’t even want to provide my Armour thyroid or antihistamine to control a sinus drip that started from Cholesterol medication last summer. I had full skin exams by dermatologists, I tried to pay privately-but nobody would do it. I should have sat outside an ER with a Buck knife, removed it and then went into to get it fixed and tried to get the ‘zit’ examined at a lab. I was given this info-and that I might get approved to have the bone and everything removed on the right side of my face on 11/28/2012-Yes this week. I’m 70, I’m poor-and if I can’t get my HMO to pay for my thyroid or the antihistamine that’s needed because the HMO bullied me into taking a med that I didn’t want-why should I expect to get any care- any care in killing the pain? I’ll go brush my teeth while I have them.

Miranda Fielding

So sorry for all your troubles–I agree, the practice of medicine is not what it used to be.

meyati

Thank you Doctor. They say-do you feel like anything is wrong? The body knows-. They won’t listen unless your feeling supports what they want to hear. For what it’s worth-my skin now looks dry in the affected area. There’s this sort of dry white flakey stuff coming out of the pores. I notice it, If people notice, they probably think I need to use a moisturizer. I told my dentist to ask about zits-see how long the zit has been there. He’s the first person to check it and realize that it was deep.